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Seth I, Gibson D, Bulloch G, Joseph K, Cevik J, Qin KR, Shahbaz S, Rozen WM. Vasovasostomy: A systematic review and meta-analysis comparing macroscopic, microsurgical, and robot-assisted microsurgical techniques. Andrology 2024; 12:740-767. [PMID: 37804499 DOI: 10.1111/andr.13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/24/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Vasovasostomy is a cost-effective procedure for the reversal of vasectomy. A water-tight adequately blood-supplied mucosal anastomosis is required for better outcomes. This review aimed to compare the outcome of vasovasostomy performed by three different techniques: macroscopic, pure microsurgical, and robot-assisted microsurgical techniques. METHODS Scopus, Web of Science, PubMed, Embase, and Cochrane library databases were searched for relevant studies from January 1901 to June 2023. We conducted our quantitative syntheses using the inverse variance method in OpenMeta software. The study's protocol was registered on PROSPERO. RESULTS This review involved 95 studies of different designs, with a total sample size of 48,132. The majority of operations were performed bilaterally, and participants were monitored for up to 10 years. The pooled patency rate was the highest following robot-assisted vasovasostomy (94.4%), followed by pure microsurgical vasovasostomy (87.5%), and macroscopic vasovasostomy (83.7%). The pooled pregnancy rate following purely microsurgical vasovasostomy was higher than that of macroscopic vasovasostomy (47.4 vs. 43.7%). Definitive pregnancy rates in robotic vasovasostomy are yet to be determined. CONCLUSION Patency outcomes for vasovasostomy were best with robot-assisted microsurgical technique, followed by pure microsurgical technique, and conventional macroscopic technique. Further investigations of robot-assisted microsurgical vasovasostomy outcomes and randomized control trials are required to support this evidence.
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Affiliation(s)
- Ishith Seth
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Damien Gibson
- Department of Surgery, Faculty of Medicine, University of New South Wales, University of New South Wales, Sydney, Australia
| | - Gabriella Bulloch
- Department of Surgery, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Konrad Joseph
- Department of Surgery, Faculty of Medicine, The University of Wollongong, New South Wales, Australia
| | - Jevan Cevik
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Kirby R Qin
- Department of Urology, Bendigo Hospital, Melbourne, Victoria, Australia
| | - Shekib Shahbaz
- Department of Urology, Monash Hospital, Melbourne, Victoria, Australia
| | - Warren M Rozen
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Farber NJ, Flannigan R, Srivastava A, Wang H, Goldstein M. Vasovasostomy: kinetics and predictors of patency. Fertil Steril 2020; 113:774-780.e3. [PMID: 32228879 DOI: 10.1016/j.fertnstert.2019.11.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the timing of patency and late failure (secondary azoospermia) after vasovasostomy (VV) using standardized kinetics definitions. DESIGN Retrospective cohort study. SETTING University-affiliated hospital. PATIENT(S) Patients with obstructive azoospermia. INTERVENTION(S) Vasovasostomy. MAIN OUTCOME MEASURE(S) Univariate and multivariate logistic regression assessed predictors of patency and late failure. Patency was defined as any sperm return to the ejaculate; and >2 million total motile sperm (TMS) in ejaculate. Late failure after VV was defined as azoospermia; or <2 million TMS in ejaculate. RESULT(S) 429 men underwent VV, with median follow up of 242 days. Mean time to patency was 3.25 months versus 5.29 months in the "any sperm" versus ">2 million TMS" groups. Finding sperm intraoperatively during VV significantly improved patency rates in multivariable analysis (odds ratio [OR] 4.22). This association was further boosted when sperm was found bilaterally (OR 6.70). Late failure rate (azoospermia) was 10.6% at mean time of 14.1 months and 23% for <2 million, at mean time of 15.7 months. When assessing predictors of late failure, intraoperative motile sperm bilaterally was a statistically significant protective factor on multivariate analysis (hazard ratio 0.22). CONCLUSION(S) Vasovasostomy remains highly efficacious in treating obstructive azoospermia. Young patients, shorter obstructive intervals, and sperm identified intraoperatively predict improved outcomes. Clinicians can expect VV patency in 3 months and late failure within the first 2 years after surgery. However, patency rates, late failure rates, and kinetics vary by definition.
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Affiliation(s)
- Nicholas J Farber
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ryan Flannigan
- Center for Male Reproductive Medicine and Microsurgery, Cornell Institute for Reproductive Medicine, Department of Urology, Weill Cornell Medicine, New York, New York
| | - Arnav Srivastava
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Hanhan Wang
- Center for Male Reproductive Medicine and Microsurgery, Cornell Institute for Reproductive Medicine, Department of Urology, Weill Cornell Medicine, New York, New York
| | - Marc Goldstein
- Center for Male Reproductive Medicine and Microsurgery, Cornell Institute for Reproductive Medicine, Department of Urology, Weill Cornell Medicine, New York, New York.
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Kavoussi PK. Vasectomy reversal: A review of the evaluation, techniques, and outcomes. World J Clin Urol 2015; 4:48-55. [DOI: 10.5410/wjcu.v4.i1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/20/2015] [Accepted: 02/12/2015] [Indexed: 02/06/2023] Open
Abstract
This review highlights the evaluation and treatment of men who have undergone vasectomy and desire vasectomy reversal to father children. For surgeons offering this treatment, the appropriate evaluation and treatment are crucial for acceptable outcomes. Although variations on surgical approaches have evolved over the years, one constant is the need for a high level of training and skill in microsurgical techniques.
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